Medicare Part D Changes for 2027: What Agents Need to Know for AEP
In short: In 2027, the Medicare Part D out-of-pocket cap rises to $2,400, up from $2,100 in 2026. The standard deductible rises to $700, up from $615. Medicare-negotiated prices for 15 more drugs, including Ozempic, Rybelsus and Wegovy, take effect January 1, 2027. Agents should run a full drug review for every client during AEP, because last year’s best plan may not be this year’s.
Prescription costs are the top worry for many Medicare clients. They’re also where a careful agent adds the most value. A plan that looks cheaper on premium can cost a client far more at the pharmacy counter.
Here’s what changes in 2027 and how to build it into your AEP reviews.
What Changes for Medicare Part D in 2027?
| 2026 | 2027 | |
|---|---|---|
| Out-of-pocket cap | $2,100 | $2,400 |
| Standard deductible | $615 | $700 |
| Negotiated drug prices | First 10 drugs | 15 more drugs added |
The cap applies to stand-alone Part D plans and to Medicare Advantage plans with drug coverage. Once a client reaches it, they pay $0 for covered Part D drugs for the rest of the year.
A temporary federal program that helped hold down Part D premiums ends after 2026. Some premiums may change, so check each client’s Annual Notice of Change.
What Counts Toward the Out-of-Pocket Cap?
Counts: what the client pays for covered, on-formulary drugs, including the deductible, copays and coinsurance.
Doesn’t count:
- Monthly premiums
- Drugs the plan doesn’t cover
- Drugs covered under Part B, like some medications given in a doctor’s office
- The $50 copay under the Medicare GLP-1 Bridge program
The old coverage gap, or “donut hole,” ended in 2025. Some clients still ask about it, so be ready to explain.
Which Drugs Get Negotiated Prices in 2027?
Negotiated prices for the first 10 drugs began January 1, 2026. Fifteen more take effect January 1, 2027. They include Ozempic, Rybelsus and Wegovy, along with drugs for COPD, cancer, diabetes and other conditions.
The negotiated price changes what the plan pays. The client’s copay is still set by the plan, so check each formulary rather than promising a specific savings amount.
How Should I Run Part D Reviews During AEP?
- Collect a current drug list, including dose and pharmacy, before the appointment.
- Read the client’s ANOC for formulary, tier and premium changes.
- Run a plan comparison for every client, not just the ones who call with a problem.
- Check pharmacies. Preferred pharmacies often mean lower copays.
- Flag help programs. Clients may qualify for Extra Help, and the Medicare Prescription Payment Plan lets clients spread out-of-pocket costs into monthly payments.
- Document everything in your CRM, including plans you compared.
AEP runs October 15 through December 7. Our AEP client review checklist covers doctors, networks and total costs too.
How Does Lourie Agent Partners Help With AEP Drug Reviews?
AEP is the busiest season of the year. We make sure you’re not doing it alone:
- Free myLourie software compares Medicare Advantage and Part D plans against each client’s prescriptions
- Extended support hours during AEP, plus phone support every business day and after-hours appointment support
- AEP training and webinars on plan changes and carrier products
- AEP direct-mail campaigns through our Advanced Marketing Program
- Direct carrier appointments, direct commission payments and full vesting from day one
See our free enrollment and CRM software and service and support.
Frequently Asked Questions
$2,400. After a client reaches it, they pay $0 for covered Part D drugs for the rest of the year.
$700, up from $615 in 2026. Some plans have a lower deductible or none.
Yes. It applies to Medicare Advantage plans that include drug coverage.
No. Only what the client pays for covered drugs counts, including the deductible, copays and coinsurance.
Negotiated prices start January 1, 2027. What the client pays still depends on the plan’s formulary and copays.
At minimum, a plan comparison tool that checks prescriptions, plus real-time support. Lourie Agent Partners provides both, with extended hours during AEP.
Get Through AEP With a Team Behind You
You may be independent, but you don’t have to work AEP alone. Our tools and team are ready when you are. Get contracted with Lourie Agent Partners or call (803) 256-2067.